The role of Type 2 Diabetes as a predisposing risk factor on the pulpo-periapical pathogenesis: review article

Jin-Hee Kim; Kwang-shik Bae; Deog-Gyu Seo; Sung-Tae Hong; Yoon Lee; Sam-Pyo Hong; Kee-Yeon Kum

doi:10.5395/JKACD.2009.34.3.169

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Kim, Bae, Seo, Hong, Lee, Hong, and Kum: The role of Type 2 Diabetes as a predisposing risk factor on the pulpo-periapical pathogenesis: review article

Review Article

Journal of Korean Academy of Conservative Dentistry

Journal of Korean Academy of Conservative Dentistry 2009; 34(3): 169-176.

Published online: 31 May 2009

DOI: https://doi.org/10.5395/JKACD.2009.34.3.169

The role of Type 2 Diabetes as a predisposing risk factor on the pulpo-periapical pathogenesis: review article

Jin-Hee Kim¹, Kwang-shik Bae², Deog-Gyu Seo³, Sung-Tae Hong⁴, Yoon Lee⁵, Sam-Pyo Hong⁶, Kee-Yeon Kum²

¹School of Dentistry, Seoul National University, Korea.

²Department of Conservative Dentistry, Dental Research Institute, BK 21 Program, Seoul National University, Korea.

³Department of Conservative Dentistry, Yonsei University, Korea.

⁴Department of Conservative Dentistry, Seoul National University, Korea.

⁵Department of Conservative Dentistry, Wonkwnag University, Korea.

⁶Department of Oral Pathology, Dental Research Institute, BK 21 Program, Seoul National University, Korea.

Corresponding Author: Kee-Yeon Kum. Department of Conservative Dentistry, Dental Research Institute, School of Dentistry, Seoul National University, 28-2 Yeongun-dong, Chongro-gu, Seoul, Korea 110-749. Tel: +82-2-2072-2656, Fax: +82-2-764-3514, kum6139@snu.ac.kr

Received 19 December 2008 Revised 19 January 2009 Accepted 21 January 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diabetes Mellitus (DM) is a syndrome accompanied with the abnormal secretion or function of insulin, a hormone that plays a vital role in controlling the blood glucose level (BGL). Type 1and 2 DM are most common form and the prevalence of the latter is recently increasing. The aim of this article was to assess whether Type 2 DM could act as a predisposing risk factor on the pulpo-periapical pathogenesis. Previous literature on the pathologic changes of blood vessels in DM was thoroughly reviewed. Furthermore, a histopathologic analysis of artificially-induced periapical specimens obtained from Type 2 diabetic and DM-resistant rats was compared. Histopathologic results demonstrate that the size of periapical bone destruction was larger and the degree of pulpal inflammation was more severe in diabetic rats, indicating that Type 2 DM itself can be a predisposing risk factor that makes the host more susceptible to pulpal infection. The possible reasons may be that in diabetic state the lumen of pulpal blood vessels are thickened by atheromatous deposits, and microcirculation is hindered. The function of polymorphonuclear leukocyte is also impaired and the migration of immune cells is blocked, leading to increased chance of pulpal infection. Also, lack of collateral circulation of pulpal blood vessels makes the pulp more susceptible to infection. These decrease the regeneration capacity of pulpal cells or tissues, delaying the healing process. Therefore, when restorative treatment is needed in Type 2 DM patients, dentists should minimize irritation to the pulpal tissue un der control of BGL.

Keywords: Atheromatous deposits, BGL, collateral circulation, histopathologic analysis, pulpo-periapical pathogenesis, Type 2 DM

Figures and Tables

Figure 1

Obliterative endarteritis in the artery of Type 2 DM(OLEFT) rat(×100).

Figure 2

Histopathological analysis of block specimens including mandibular first molars and periapical bone. In the OLEFT (A, Type 2 DM rat) group, there were lots of inflammatory cells such like macrophages, lymphocytes, and plasma cells in the large periapical lesion of the mesio-buccal roots (A). In the LETO (B, DM-resistant rat) group, there was relatively small apical lesion with inflammatory cells and apoptotic bodies(×100, unpublished data).

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